Get the free Diabetes Assessment Form - Northern Health

Diabetes Services Fax: 9308 3022 Dear Referrers, Please find below information on how to refer to Northern Health suite of Diabetes Services which includes Endocrinology, Diabetic Nurse Practitioner,

How to fill out diabetes assessment form

1. To fill out a diabetes assessment form, start by gathering all necessary personal information such as your full name, date of birth, and contact details.
2. Proceed by answering the questions related to your medical history, including any previous diagnosis of diabetes or other related conditions.
3. Provide accurate information about your family history of diabetes, as it may help determine your risk and potential need for further testing.
4. Indicate any symptoms you may be experiencing, such as frequent urination, excessive thirst, unexplained weight loss, or blurred vision, to help healthcare professionals assess your condition better.
5. When filling out the assessment form, be as honest and detailed as possible regarding your lifestyle habits, including your diet, exercise routine, and alcohol or tobacco consumption. This information can assist in creating an appropriate treatment plan.
6. If you are currently taking any medications, it is crucial to note them down on the form, as they can affect your diabetes management and the overall assessment.
7. Include any recent blood test results or medical reports relevant to your diabetes, if available. This information can provide valuable insight into your current health status.
8. Finally, sign the form and make sure to date it before submitting it to the appropriate healthcare professional or organization.

Regarding who needs a diabetes assessment form, it is typically required for individuals who suspect they may have diabetes, those with a family history of diabetes, or individuals who have been advised by their healthcare provider to undergo a diabetes assessment. Additionally, healthcare organizations, clinics, and hospitals may request patients to complete a diabetes assessment form for routine screening or when seeking treatment for related conditions.

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